1. COMMUNITY TEAM + Basic Principles of Systems Thinking

2. Sessions Will Cover AM -Double Loop Learning -Back ground to systems thinking -Difference between systems and services -Value and Failure Demand -Taguchi Curve -System Perspective -System Purpose and Capability -System Conditions -Basic System theory and intervention theory -Basics about this next stage of the intervention PM -Waste -Normative Learning -Mapping Demand -Mapping flow -Set you a task

3. Can you give examples of typical performance problems? Can you give me typical examples of how organisations resolve these performance problems? What are the logics that sit behind these actions?

4. Most of our management actions and system changes assume the system is basically OK, we just need to motivate the people.

5. But what if it isn’t the people? What I said to you at least some of it is caused by the way the system is designed and managed? What if I said to you at least 50% of it is caused by the way the system is designed and managed? What if I said to you at least 90% of it is caused by the way the system is designed and managed?

6. So Why Don’t We See This? ‘Out of the Crisis’ Toyota Production System

7. What’s the Difference Between a Service and a System? Chief Housing Officer Supervisor Tradesmen Inspector Receptionist Works Manager

8. Repairs as a System Call Centre Works order Supervisor Tradesman Materials Access Repair “Something’s broken…” Service Level, AvHT Diagnosis & SoR Target Times, Budget Diagnosis,B onus, Fix Cancel WO’s favouritism Delay No. Jobs Type of job 40% fail 95% WO’s Reworked Parts/material Priority Activity, Time, Cost Prop. o/heads Re-allocate Argue “What’s going on!” “It’s not fixed!” 65% Bonus Distrust

9. Systems Thinking 'failure demand' - demand caused by a failure to do something or do something right for the customer and 'value demand' - what the call centre exists to provide All work waiting to be done, is work to do Capacity = work + waste Demands are requests for service by, or on behalf of, the service user, including situational demands?

10. £ Nominal Value Why Does This Matter? Taguchi Curve

11. “He is very sweet and patient. He has saved my sight and I’m very happy. Halellulah!” “I don’t know what is likely to happen” “Until I get my appointment date my life is on hold” “I am 85 and reading is my life now” “The doctor kept getting interrupted and asked me the same question three times. It’s a safety concern” “I don’t mind when it is, but because I work I need to know” “I’m waiting for an appointment, but I’d like to speak to someone because I’m worried” “They rescheduled my operation, they simply don’t understand what this means to me” “I know you are busy, but I matter” WHATMATTERSWHATMATTERS WHATMATTERSWHATMATTERS Nominal Values Reflect What Matters to Service Users

12. Outside In Break into groups of three or four and examine the case study examples Try to get into the shoes of the service user identify what matters to them Discuss the pros and cons Summarise in the words of the service user what matters Suspend any thoughts about what usually happens, or any judgement of what matters to them

13. So What Are We Here For? - Break into groups and spend 3 mins identifying what the purpose of our system is. (This is one of those no right answer things, but think about management preoccupations) -Break into groups again and identify from your private life (you or someone close to you) a memorable interaction with a public sector organisation? - What matters/mattered to you? - What do you think the purpose of that system is?

14. So What Are We Here For? What is the purpose of the system? The purpose of the system is….. When we study the existing work we see the de facto purpose When we study value demand we see the real purpose

15. Capability De Facto Purpose. Purpose from outside-in. When we consider performance against the de-facto purpose, it tells one story When we consider performance against the outside-in purpose, it can tell another story Examples?

16. System Conditions Why is doing better things difficult? Break into groups again and identify examples of change projects, or major changes that haven’t worked as well as intended.

17. “you cannot solve a problem with the same thinking that caused it”

18. Thinking System Performance “Same Things Better” “Better Things” System conditions are things that cause the system to behave the way it does.

19. Traditional Thinking Top Down, hierarchy Separated from work Control Reactive, projects, by plan Extrinsic Functional specialism Outputs, targets, standards: Relate to budget Contractual Make #’s & manage people Outside In, system Integrated with work Learning Adaptive, integral, emergent Intrinsic Demand, Value, Flow Capability and variation: Relate to purpose What matters? Co-operation, mutuality Act on the system Perspective Decision making Ethos Change Motivation Design Measurement Attitude to customers Attitude to suppliers Role of management Systems Thinking

20. New Ethos You need to help solve a problem called ‘learning how to build the new model at scale’. We’ve got to land that learning so it will require us to be creative but also industrious.

21. Systems Thinking Intervention Approach UnlearnLearn DissonanceResonance

22. This is a complex, system and we will need to keep many plates spinning, so we need your help to; -Work as a team -Bring your skills, but not your roles -Take responsibility for learning -Think outside the box (if there is a box in the first place) -Keep the pace up

23. Specific Redesign Roles Operational Lead – understand, capture and synthesise what is and isn’t working, learn method and unblock problems, ‘sweeper’. Crystallisers – Land learning and turn into products Strategy – understand strategic implications and implications for roles, work design and measures Team – to learn how to meet purpose at scale and develop value work Fort Holders – Keep business running as usual, promote smooth transition to new model, assist in developing new model

24. Mapping Demand and Flow ‘Get Knowledge’

25. ‘In god we trust others must bring data’ William Deming Principle: Base decisions on knowledge.

26. Control V’s Learning Ethos Chief Housing Officer Supervisor Tradesmen Inspector Receptionist Works Manager ‘Processes should be followed’ ‘What can we learn’’ Inhibits learning, problems hidden, Knowledge diluted through hierarchy. Normative Learning

27. Mapping Flow Capacity = Work + Waste 1.Work (Often called value added) ‘The activity changes the product or service towards something that the customer wants’ 2. Waste (often called non value added) -Enabling activity (work) -Mandatory (usually legal requirement) -Pure waste

28. ‘I need a small car that’s easy to drive’ What are the two consequences of not just meeting her nominal value (what matters to her)? Unmet need Overproduction This is Not Just About Reducing Waste

29. Consequences of Not Meeting What Matters in this System Low to high Triangle of complexity / need

30. Another Consequence of Waste Activity? Capacity = Work + Waste Waste uses up desperately needed resource

31. Potential Tensions In This System MandatoryBest practice and guidance Risk ManagementRisk elimination You need to work out how much of writing things on screens and on files is ‘work’ or mandatory?

32. Demand Mapping 1.Introduce yourself and explain what you are doing. 2.Stress you are here to listen to service user demands, not how they are dealt with. 3.Listen to the conversation directly with earphones (rather than just the response). 4.Write notes of what the service user says. 5.If you can see the service user, observe them and make notes about any non-verbal or situational signals that may be indicating what matters to them. 6.As soon as practicable, summarise in one or two sentences what matters to the service user (in their words, phased outside in). 7.Write down whether it was a value or failure demand (See earlier definition) 8.Write down whether it was successfully dealt with first time (according to the service user). (If calls go quiet then use the same techniques with any written requests for service such as letters or referrals)

33. DemandValue or Failure 1 st time

34. Mapping Flow 1.Introduce yourself and explain what you are doing. We want knowledge of what actually happens so go out of your way to put them at ease and reassure 2.Pick up a typical case mid process and follow the flow backwards and forwards. 3.Record what actually typically happens (not what procedures manuals or managers say should happen). 4.Write down the main steps and events on post it notes. 5.Write down any issues you come across or hear about and write them on a post it note together with what you believe the cause was. 6.Divide into smaller groups if the process is too long to map in a day. 7.Note down if the case was known to us previously and how many cycles it may have been through. 8.When you come back together organise the post-it notes into a continuous flow from start to finish. 9.Write down the issues and causes at the relevant points in the flow.

35. Too Much Detail

36. Not Enough 70% 13% 17% Clinic Appointment Receive Letter Write to Referral form other to other Ass Specific or soon as pos 68% 71 Days 27 Days 40 Days GP

37. Practising Mapping Flow Break into three groups Identify a non social care flow that someone knows well By asking questions, map the key events and steps within that process from end to end.

38. The Task By Thursday Lunchtime, - Identified typical demands in the system (Expressed in the service user terms) -Got some data on how many are value and failure -Identified a purpose for the system (based on demand and expressed in the service user terms) -Mapped the typical flow end to end -Identified on the flow the main issues and causes -Fed back to each other (a good cross section to do the feeding back) (Don’t worry about how robust it is)